Dataset Information

Anthracycline-induced cardiotoxicity: prospective cohort study from Pakistan.

ABSTRACT:

Objectives

To identify anthracycline-induced acute (within 1 month) and early-onset chronic progressive (within 1 year) cardiotoxicity in children younger than 16 years of age with childhood malignancies at a tertiary care centre of Pakistan.

Design

Prospective cohort study.

Setting

Aga Khan University, Karachi, Pakistan.

Participants

110 children (aged 1 month-16 years).

Intervention

Anthracycline (doxorubicin and/or daunorubicin).

Outcome measurements

All children who received anthracycline as chemotherapy and three echocardiographic evaluations (baseline, 1 month and 1 year) between July 2010 and June 2012 were prospectively analysed for cardiac dysfunction. Statistical analysis including systolic and diastolic functions at baseline, 1 month and 1 year was carried out by repeated measures analysis of variance.

Results

Mean age was 74±44 months and 75 (68.2%) were males. Acute lymphoblastic leukaemia was seen in 70 (64%) patients. Doxorubicin alone was used in 59 (54%) and combination therapy was used in 35 (32%). A cumulative dose of anthracycline <300 mg/m(2) was used in 95 (86%). Fifteen (14%) children developed cardiac dysfunction within a month and 28 (25%) children within a year. Of these 10/15 (66.6%) and 12/28 (43%) had isolated diastolic dysfunction, respectively, while 5/15 (33.3%) and 16/28 (57%) had combined systolic and diastolic dysfunction. Seven (6.4%) patients expired due to severe cardiac dysfunction. Eight of 59 (13.5%) children showed dose-related cardiotoxicity (p=<0.001). Cardiotoxicity was also high when the combination of doxorubicin and daunorubicin was used (p=0.004).

Conclusions

Incidence of anthracycline-induced cardiotoxicity is high. Long-term follow-up is essential to diagnose its late manifestations.

SUBMITTER: Shaikh AS

PROVIDER: S-EPMC3840341 | biostudies-literature | 2013 Nov

REPOSITORIES: biostudies-literature

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Publications

Anthracycline-induced cardiotoxicity: prospective cohort study from Pakistan.

Shaikh Abdul Sattar AS Saleem Ali Faisal AF Mohsin Shazia Samad SS Alam Muhammad Matloob MM Ahmed Mehnaz Atiq MA

BMJ open 20131120 11

<h4>Objectives</h4>To identify anthracycline-induced acute (within 1 month) and early-onset chronic progressive (within 1 year) cardiotoxicity in children younger than 16 years of age with childhood malignancies at a tertiary care centre of Pakistan.<h4>Design</h4>Prospective cohort study.<h4>Setting</h4>Aga Khan University, Karachi, Pakistan.<h4>Participants</h4>110 children (aged 1 month-16 years).<h4>Intervention</h4>Anthracycline (doxorubicin and/or daunorubicin).<h4>Outcome measurements</h4 ...[more]

PMID: 24259388

Similar Datasets

Project description:BackgroundDoxorubicin and other anthracycline derivatives inhibit topoisomerase II and is an important class of cytotoxic chemotherapy in cancer treatment. The use of anthracycline is limited by dose-dependent cardiotoxicity, which may manifest initially as asymptomatic cardiac dysfunction with subsequent progression to congestive heart failure. Despite baseline assessment and periodic monitoring of cardiac function for patients receiving anthracycline agents, there are unmet needs in prediction and prevention of anthracycline-induced cardiotoxicity (AIC).Case summaryA 35-year-old African American female was found to have a 9-cm high-grade osteosarcoma of right femur and normal baseline cardiac function with left ventricular ejection fraction of approximately 60%-70% determined by transthoracic and dobutamine stress echocardiogram. She underwent perioperative doxorubicin and cisplatin chemotherapy with 3 cycles before surgery and 3 cycles after surgery, and received a total of 450 mg/m2 doxorubicin at the end of her treatment course. She was evaluated regularly during chemotherapy without any cardiac or respiratory symptoms. Approximately two months after her last chemotherapy, the patient presented to the emergency department with dyspnea for one week and was intubated for acute hypoxic respiratory failure. Echocardiogram showed an ejection fraction of 5%-10% with severe biventricular failure. Despite attempts to optimize cardiac function, the patient's hemodynamic status continued to decline, and resuscitation was not successful on the seventh day of hospitalization. The autopsy showed no evidence of osteosarcoma, and the likely cause of death was cardiac failure with the evidence of pulmonary congestion, liver congestion, and multiple body cavity effusions.ConclusionWe present a case of 35-year-old African American female developing cardiogenic shock shortly after receiving a cumulative dose of 450 mg/m2 doxorubicin over 9 mo. Cardiac monitoring and management of patients receiving anthracycline chemotherapy have been an area of intense research since introduction of these agents in clinical practice. We have reviewed literature and recent advances in the prediction and prevention of AIC. Although risk factors currently identified can help stratify patients who need closer monitoring, there are limitations to our current understanding and further research is needed in this field.

Dataset Information

Anthracycline-induced cardiotoxicity: prospective cohort study from Pakistan.

Objectives

Design

Setting

Participants

Intervention

Outcome measurements

Results

Conclusions

Publications

Anthracycline-induced cardiotoxicity: prospective cohort study from Pakistan.

Similar Datasets

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